Leg Pain When Walking in Ajax: Ultrasound and Artery Health

Picture a familiar walk: from the far end of a parking lot to the store entrance, or a loop around the neighbourhood after dinner. Partway through, a cramp or ache builds in one calf. You slow down, then stop. After a minute or two of standing still, the pain fades, and you carry on until it returns at roughly the same distance.

Many people shrug this off as getting older, being out of shape or a stiff muscle. Sometimes it is one of those things. But that particular pattern, pain that arrives with walking and leaves with rest, is also a classic sign that the arteries carrying blood to the legs may have narrowed. The condition is called peripheral artery disease, or PAD, and it is worth taking seriously, not only for your legs but for what it can say about blood vessels elsewhere in the body.

This article is organized around the questions patients in Ajax and nearby communities most often have when leg pain leads to a referral for an arterial ultrasound.

What exactly is happening in the arteries?

Arteries carry oxygen-rich blood from the heart to the rest of the body. Over many years, fatty material, cholesterol, calcium and other substances can build up inside artery walls, forming plaque. This process, atherosclerosis, gradually narrows the channel through which blood flows.

At rest, your leg muscles need relatively little blood, so a narrowed artery may still supply enough. When you walk, the muscles demand much more. If the narrowed artery cannot deliver the extra blood, the muscles run short of oxygen and start to hurt. Stop walking, the demand drops, and the pain eases. That is why the symptom follows such a predictable pattern.

The same process can affect arteries throughout the body. Narrowing in the arteries of the neck is discussed in our article on carotid ultrasound and stroke risk; narrowing in the arteries of the heart is linked to angina and heart attacks. PAD is the version of the problem that shows up in the legs.

What does PAD feel like?

The medical term for walking-related leg pain is intermittent claudication. People describe it in different ways:

• cramping, aching or tiredness in the calf, the most common spot
• a similar feeling in the thigh or buttock, depending on where the narrowing is
• pain that comes on after a fairly consistent distance or on hills and stairs
• relief after a few minutes of standing still, without needing to sit or bend forward

Not everyone with PAD has this classic pain. Some people have no symptoms at all, and some notice other changes instead:

• one foot or leg that feels colder than the other
• slower growth of toenails or loss of hair on the lower legs and feet
• shiny or pale skin on the legs
• a weaker pulse in the feet, which a doctor may notice during an exam
• sores on the toes, feet or lower legs that are slow to heal

In men, PAD can sometimes be linked with erectile difficulties, since the same artery changes can affect blood flow to the pelvis. That can be an awkward thing to mention, but it is a useful piece of information for your doctor.

Could it be something else?

Yes, and this is one of the reasons a proper assessment matters. Several other conditions can cause leg pain when walking:

• Narrowing in the lower spine, sometimes called spinal stenosis, can cause leg pain or numbness when standing or walking. A clue is that it often eases with sitting or leaning forward, such as over a shopping cart, rather than simply standing still.
• Arthritis in the hip or knee tends to cause pain in the joint itself, may be present at the start of a walk and can vary from day to day.
• Nerve problems, including those related to diabetes, can cause burning, tingling or numbness that does not follow the walk-and-rest pattern.
• Muscle strain or overuse usually follows a specific activity and improves over days.
• Vein problems can cause heaviness and swelling that are often worse at the end of the day rather than tied to walking distance. Our article on varicose veins and venous ultrasound covers that side of leg circulation.

Your health-care provider will consider your history, examine your legs and feet and decide which tests make sense. You do not need to sort this out on your own.

Who is most at risk?

The risk factors for PAD overlap heavily with those for heart disease and stroke. They include:

• smoking, which is one of the strongest risk factors for PAD, whether current or past
• diabetes
• high blood pressure
• high cholesterol
• older age
• a personal or family history of heart disease, stroke or circulation problems
• kidney disease

If you have several of these, it is reasonable to ask your doctor whether your leg circulation should be checked, even if you do not have pain.

Which symptoms need emergency care?

Most PAD develops slowly. A sudden blockage of an artery to the leg is different, and it is a medical emergency.

Call 911 or go to the nearest emergency department right away if a leg or foot suddenly becomes:

• severely painful
• pale, blue or cold to the touch
• numb, weak or difficult to move

These signs can mean that blood flow has been cut off suddenly and needs urgent treatment. Do not wait for an appointment or go to a community imaging clinic.

You should also contact your doctor promptly, without waiting for a routine visit, if you have a sore, ulcer or area of darkened skin on your foot or toes that is not healing, or pain in the foot or toes that comes on even at rest, especially at night when lying flat. These can be signs of more advanced reduced blood flow.

How do doctors check leg arteries?

Assessment usually starts in the doctor’s office. Your provider will ask about your symptoms and feel the pulses in your legs and feet. Many also use a simple test that compares blood pressure at the ankle with blood pressure in the arm, often called the ankle-brachial index. A lower pressure at the ankle can suggest narrowing somewhere along the way. Ask your provider where this test can be done if they recommend it.

If more detail is needed, an arterial ultrasound of the legs is often the next step.

What does an arterial leg ultrasound show?

An arterial ultrasound of the legs uses sound waves and Doppler to follow the main arteries from the groin down toward the ankle. It can help show:

• Where narrowing is located, such as in the thigh, behind the knee or in the calf
• How significant the narrowing appears, based in part on how much the blood speeds up as it passes through a tight spot
• Whether an artery appears blocked, and whether blood is finding a way around through smaller vessels
• The pattern of flow below a narrowing, which tends to change in a recognizable way when an artery upstream is narrowed

For people who have had a procedure on a leg artery, such as a bypass or stent, ultrasound can also be used for follow-up monitoring, at their specialist’s request.

Like all ultrasound, the exam uses no radiation and no injection. In some people, depth, body shape or heavy calcium in the artery walls can make parts of the arteries harder to see clearly. If that happens, the report will say so, and your doctor may decide whether another type of imaging is needed.

What happens during the appointment?

You will lie on an exam bed, usually on your back, and may be asked to roll partly onto your side for views behind the knee. You will need to uncover the legs, so loose clothing that is easy to change out of is helpful. The technologist applies gel and moves the transducer along each artery in turn, stopping to take images and measurements. You may hear a pulsing whoosh from the Doppler signal; in healthy leg arteries it often has a crisp, rhythmic quality that changes where flow is affected.

The exam is painless, though pressing near the groin or behind the knee may feel a little uncomfortable. Tell your technologist if you need to change position. Preparation for vascular exams varies, and our team will confirm any instructions when your appointment is booked. Bring your health card and requisition.

What comes after the scan?

The findings are sent to your referring doctor, who will explain them and talk about next steps. These often focus on two goals at once: easing leg symptoms and lowering the risk of heart attack and stroke, since PAD is often a sign that arteries elsewhere may be affected too.

Your doctor may talk with you about stopping smoking, managing blood pressure, cholesterol and blood sugar, and a structured walking program, which many people find helps them walk further over time. Some people are referred to a vascular specialist. Your doctor may also recommend heart testing, such as an electrocardiogram or echocardiogram; these are offered through our cardiology team, Durham Cardiology. Every plan is individual, and decisions about medication or procedures are made with your health-care team.

If you have diabetes, foot care becomes especially important when circulation is reduced. Checking your feet daily for cuts or sores and wearing well-fitted shoes are commonly recommended. Ask your provider what applies to you.

Booking an arterial ultrasound in Ajax

Arterial studies of the legs are part of our vascular ultrasound service, performed by certified technologists. Rossland Diagnostic Clinic is at Unit 102, 300 Rossland Road East in Ajax, on the ground floor with free parking near the door, which makes a difference when walking is what hurts. We see patients from Ajax, Pickering, Whitby and across Durham Region.

If your doctor has given you a requisition, call 905-426-3111 or request an appointment. And if walking-related leg pain is new to you, start with a visit to your family doctor; it is a conversation worth having.